Predicting eczema severity beyond childhood
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Predicting eczema severity beyond childhood Kam Lun Hon, Yin-Ching K. Tsang, Terence Chuen W. Poon, Nga Hin Pong, Matthew Kwan, Shirley Lau, Yuen-Chun Chiu, Hin-Hei Wong, Ting-Fan Leung Hong Kong, China Background: We evaluated factors associated with eczema severity in adolescence.
Results: Adolescence-NESS (n=383 patients) was associated with eczema onset in infancy, dust mite and food allergen sensitization, dietary avoidance, use of wet wrap, traditional Chinese medicine, immunomodulant (azathioprine or cyclosporine), high IgE level, eosinophil count, but not with family/personal history of atopy. Eighty-two patients had both childhood-NESS and adolescence-NESS (mean follow-up of 6.8 years) showing that adolescence-NESS was associated with childhoodNESS severity grades (P=0.034). Of these patients, 48% remained in the same severity grades, whereas 39% improved, and 13% deteriorated from childhood to adolescence. Conclusions: It is not possible to assure parents that their child can outgrow eczema. In eczema prognosis research, long-term follow-up is warranted. World J Pediatr December 2015; Online First Key words: atopic dermatitis; atopy; eczema; Nottingham Eczema Severity Score; prognosis
Author Affiliations: Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (Hon KL, Tsang YCK, Poon TCW, Pong NH, Leung TF); Faculty of Medicine, The Chinese University of Hong Kong (Kwan M, Lau S, Chiu YC, Wong HH) Corresponding Author: Kam Lun Hon, MD, Department of Pediatrics, The Chinese University of Hong Kong, 6/F, Clinical Science Building, Prince of Wales Hospital, Shatin, Hong Kong (Tel: 852 2632 2859; Fax: 852 2636 0020; Email: [email protected], [email protected]) doi: 10.1007/s12519-015-0064-9 ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2016. All rights reserved.
World J Pediatr, Online First, December 2015 . www.wjpch.com
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hildhood eczema is a chronic distressing disease. [1-7] Disease onset is usually before 5 years of age in the majority of patients.[2,6,8] The prevalence of atopic diseases among these individuals and their family members are high and include eczema, asthma or allergic rhinitis. Atopy is also evidenced in laboratory tests (such as positive skin prick reaction to common food and aeroallergens or elevated serum IgE levels above laboratory reference range for age).[4,6,7,9,10] Parents are often assured that eczema is characterized by periods of exacerbation and remission with a natural tendency to improve or resolve eventually when their child reaches adolescence. However, there are only few long-term studies to provide evidence for this notion. Risk factors of persistent diseases include severe disease and early food allergy.[11-15] We evaluated factors associated with eczema severity in adolescence.
Methods
The clinical data of consecutive patients with atopic eczema (AE) followed up at the pediatric dermatology clinic of our university hospital were reviewed. Eczema was diagnosed ac
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